In countries like the US and UK, people with Down syndrome are gaining more visibility year by year. In Iceland, however, they’ve almost completely disappeared. A recent CBS News probe has revealed why only 2 Icelandic children are born with Down syndrome each year on average, and their findings have sparked a fierce ethics debate online.

Landspítali, or the National University Hospital of Iceland, has been offering prenatal screening tests to pregnant women since the early 2000s, an essential step in detecting development problems in a fetus – including Down syndrome. Unlike the estimated 67% of women in the US who choose to terminate their pregnancies upon diagnosis of the disorder, nearly 100% of Icelandic women do so, making Down syndrome extremely rare in the island nation. “My understanding is that we have basically eradicated, almost, Down syndrome from our society,” geneticist Kari Stefansson told CBS.

Contrary to Internet accusations of forced abortions and ‘social cleansing,’ all of these abortions performed in Iceland were completely of the mother’s own volition. “We try to do as neutral counseling as possible, but some people would say that just offering the test is pointing you towards a certain direction,” said head of Landspítali’s Prenatal Diagnosis Unit Hulda Hjartardottir.

Despite the often poor prognosis for children with Down syndrome, and the costs associated with their care that are borne by their families, some are still arguing that their existence should be valued by society, and that terminating all Down’s pregnancies is unethical.